Analyzing the records of 9,973 patients who came to the University of Colorado Hospital emergency department between 2012 and 2016, the researchers, led by Andrew A. Monte, MD, PhD, of the University of Colorado School of Medicine in Aurora, discovered that the frequency of cannabis-related ER visits increased each year from 2012 through 2016, with the total number more than tripling during that period.
In Colorado, edibles make up only 0.32 percent of total cannabis sales, but these edibles—foods containing cannabis extract—were responsible for 10.7 percent of emergency visits, according to the research article published in the Annals of Internal Medicine.
Colorado laws removed the ban on medical marijuana in 2009 and liberated recreational cannabis in 2014. A Colorado Behavioral Risk Factor Surveillance System survey, conducted by Colorado Department of Public Health & Environment, showed that 40.4 percent of users smoke cannabis, and 3.6 percent use edible products exclusively; the rest use a combination of the two.
“Although less frequent overall, edible products lead to more acute psychiatric events and cardiovascular symptoms than inhaled exposure,” wrote Monte. People who end up in the ER after consuming edibles exhibit cardiovascular symptoms as well as cannabinoid hyperemesis syndrome, a condition that leads to bouts of severe panic attacks, vomiting, and psychosis.
The study also noted that the only deaths in Colorado that have been conclusively linked to cannabis use have involved edible products. A particularly notable case took place in 2014. A 19-year-old man died in Colorado after eating 6 times the recommended dose of a marijuana cookies and then jumping off a fourth-story balcony.
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“If inhalable and edible cannabis were equally toxic and resulted in the same number of ED visits, we would expect that 0.3% of cannabis-attributable visits would be due to use of edible products,” Monte explained to Medpage Today. “The observed proportion of cannabis-attributable visits with edible exposure was about 33 times higher than expected (10.7% vs 0.32%) if both routes of exposure were equally toxic.”
This higher-than-expected number of adverse events “is consistent with prior findings, including a 2017 poison control center report in which edible products accounted for 17% of cannabis-related visits to health care facilities among adults,” wrote Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA) in Bethesda, Maryland and Ruben Baler, PhD, of NIDA’s Office of Science Policy and Communications in an accompanying Annals of Internal Medicine editorial.
In the current Morbidity and Mortality Weekly Report: The case of the 19-year-old who leapt to his death after eating too much THC in a cookie.
One major reason edibles are more problematic than inhalants, according to the Centers for Disease Control and Prevention (CDC) is that it takes longer for the body to absorb tetrahydrocannabinol (THC) when it’s orally ingested, therefore people may consume more to feel the effects faster. This may lead to people consume very high doses resulting in extreme symptoms.
The authors note that because they can’t be sure that edible cannabis sales in the Denver area are similar to the rate in the state overall, the proportion may be different depending on regions. Despite this and other uncertainties, the authors suggest that other jurisdictions considering cannabis legalization might take into account the relative toxicity of edible products.
“At the very least, users must be educated about the delayed kinetic profile and the increased risk for acute psychiatric and adverse cardiovascular events associated with edible ingestion,” said Monte and colleagues.